Asked by: Lord Hylton (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether there is a recommended time after a person has been detained under the Mental Health Act 1983 at which there must be a comprehensive review of all the available medical evidence in that case.
Answered by Lord O'Shaughnessy
Every patient detained under the Mental Health Act 1983 must be assigned a Responsible Clinician, who must review cases regularly to make decisions about treatment, review detentions, and make decisions on discharge. These decisions are based on a consideration of a person’s mental disorder, of the risk the person may present to themselves or others, and on appropriate medical treatment being available for the person.
If a patient disagrees, and is detained under section 2 and section 3 of the Mental Health Act 1983 - the majority of detentions - he or she is able to apply to a tribunal to appeal their section. Applications can also be made by the patient’s nearest relative. The Act sets out the required times when appeals can be made. Patients admitted to hospital for assessment under section 2 of the Act can be detained for up to 28 days and can appeal to the Tribunal within the first 14 days. For patients detained under the long term section 3, patients can apply once in the first six months of their detention and annually after that.
The Tribunal will consider evidence such as a medical report, a nursing report and a social circumstances report on the patient’s case. In determining whether to discharge the patient, the Tribunal must have regard to the patient's history of mental disorder and any other relevant factors, what risk there would be of a deterioration of the patient's condition if he were to continue not to be detained in a hospital.
In the absence of an application by the patient or their nearest relative, Hospital managers have a duty under section 68 of the Act to refer patients to a tribunal six months after the person was first detained. In addition hospital managers must refer any patients over 18 who have spent three years without the Tribunal considering their detention.
Asked by: Lord Hylton (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what percentage of permanent psychiatric and mental health practitioner posts in England are currently held by locums; and what assessment they have made of the impact of the use of locum practitioners on the quality and effectiveness of treatments.
Answered by Lord O'Shaughnessy
Information concerning the percentage of permanent psychiatric and mental health practitioner posts in England is not held centrally.
Many locum workers are substantive employees, known to the trusts. By encouraging mental health trusts to offer bank staff long term placements the continuity of care is promoted.
Asked by: Lord Hylton (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether NHS guidelines require periodic reviews to be conducted in cases of patients with severe mental ill-health; and if so, whether both physical and mental health issues are reviewed at the same time.
Answered by Lord O'Shaughnessy
In general, mental health trusts use the Care Programme Approach (CPA), which is a framework for people under the care of secondary mental health services at high risk or with multiple, complex needs that require planning and co-ordination across different services. Government guidance on the CPA published in 2008 recommends that all patients placed on the CPA should receive a formal review at least every 12 months. Many trusts operate a policy of at least six-monthly reviews.
In 2018/19, NHS England is developing a new framework for adult non-specialist community mental health services, which will set out updated recommendations on the co-ordination, planning and reviewing of physical and mental health care.
Asked by: Lord Hylton (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether the NHS rules and guidelines for psychotropic medicines apply equally to general practitioners, specialists, and consultants.
Answered by Lord O'Shaughnessy
All healthcare professionals are expected to follow professional clinical guidelines around the use of psychotropic medicines. Information about the use of medicines is also included in the summary of product characteristics for healthcare professionals and in the patient information leaflet.
Asked by: Lord Hylton (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether the powers to restrict an individual’s liberty in the Mental Health Act 2007 are used differently within the regions of England, and between England, Wales and Scotland.
Answered by Lord O'Shaughnessy
The Mental Health Act 1983, as amended in 2007, operates in England and Wales only. The powers under the Mental Health Act 1983 are the same within the regions of England.
Asked by: Lord Hylton (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government how many adults are currently sectioned under the Mental Health Act 2007; and what is the (1) average, and (2) median lengths of the restrictions to which they are subject.
Answered by Lord O'Shaughnessy
The information is not available in the format requested.
Asked by: Lord Hylton (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what percentage of sectioned persons seek a second opinion about their treatment.
Answered by Lord O'Shaughnessy
The information requested is not collected.
Asked by: Lord Hylton (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether the National Institute for Health and Care Excellence has issued guidance on prescribing psychotropic medicines; and if so, what precautions are advised to ensure that prescribed drugs are suitable for individual patients and that their use is not unnecessarily prolonged.
Answered by Lord O'Shaughnessy
The National Institute for Health and Care Excellence (NICE) has issued a large range of guidance covering the use of psychotropic medicines, including through its clinical guidelines programme. NICE clinical guidelines provide detailed guidance for healthcare professionals and should be taken fully into account by prescribers in the care of individual patients.
NICE is also scheduled to develop a clinical guideline on the safe prescribing and withdrawal management of prescribed drugs that is expected to begin in early 2019.
We have taken the term ‘psychotropic medicines’ to refer to all psychiatric medication that is used to treat mental illnesses: this includes antidepressants, antipsychotics and mood stabilisers.
Asked by: Lord Hylton (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether consultant psychiatrists who have assessed or treated patients with mental illnesses remain responsible for those patients when they are moved to other hospitals or discharged; and if so, for how long.
Answered by Lord O'Shaughnessy
In general, when patients are moved to other hospitals the referring consultant psychiatrist transfers responsibility to the receiving consultant. When a patient is discharged from hospital, they are either followed up by a community mental health service or by their general practitioner (GP) in primary care. When a patient is transferred to a community mental health service, responsibility generally transfers to the consultant in that service.
There are some exceptions, including:
- Patients detained under the Mental Health Act (MHA) 1983 may be given ‘leave of absence’ to another hospital as part of their discharge plan. The transferring consultant, who has ‘Responsible Clinician’ status under the MHA, remains responsible for that patient during the authorised leave period and may recall the patient if necessary; and
- When a patient is followed up under a shared care arrangement between their GP and the secondary care consultant. This is normally managed under a locally agreed protocol.
There are no time limits ascribed to these responsibilities.
Asked by: Lord Hylton (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether they plan to take steps to increase the number of training posts for speech and language therapists available in 2016–17.
Answered by Lord Prior of Brampton
The National workforce plan for England 2015-16 outlines that commissions for Speech and Language Therapists has increased since 2014-15 by 3.7%.
Health Education England is currently working with local organisations and key external stakeholders to develop the National Workforce Plan for England covering the period 2016-17. This will be published in December 2015. The plan takes account of what local providers require by way of future staffing levels including Speech and Language Therapists.